IC-33 Key Notes Combined

8/20/2019 IC-33 Key Notes Combined

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IC-33 Life Insurance

Chapter 1

Introduction to Insurance

Life Insurance – History and evolution

Intro: This chapter presents the basics of insurance and how it works as a tool for risk transfer .

History of Insurance inIndia

Modern insurance inIndia began in early 1800

or thereabouts

It began with agencies offoreign companies startingmarine insurance business

The first life insurancecompany in India

was an Englishcompany

The Oriental LifeInsurance Co. Ltd

The first non-lifeinsurance company

established inIndia

Triton InsuranceCo. Ltd.

The first Indianinsurance company

was formed in1870 in Mumbai

Bombay MutualAssuranceSociety Ltd.

The oldest insurancecompany in India

was founded in1906 & still in

business

NationalInsuranceCompany Ltd.


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Chapter 1


Life Insurance Companies Act, 1912 was passed to regulate insurance business

Insurance Act, 1938 was the first legislation enacted to regulate conduct of insurance companies

• Life insurance business was nationalised on 1st September, 1956

• The Life Insurance Corporation of India (LIC) was formed.

Nationalisation of life insurance

• The non-life insurance business was nationalised with the enactment of GeneralInsurance Business Nationalisation Act (GIBNA) in 1972,

• The General Insurance Corporation of India (GIC) and its four subsidiaries wereset up

Nationalisation of non-life insurance

• The passing of the Insurance Regulatory & Development Act, 1999(IRDA) led to theformation of Insurance Regulatory and Development Authority (IRDA) in April 2000as a statutory regulatory body both for life and non-life insurance industry.

Insurance Regulatory and Development Authority (IRDA)


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Chapter 1


How insurance works

InsuranceProcess where losses of a few are shared by others

exposed to similar uncertain events / situations

Insurance

process

Risk burdens thatone carries

Primaryburden of risk

Secondaryburden of risk


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Chapter 1


Risk management techniques

Risk management techniques

Risk avoidance Risk retentionRisk reduction and

controlRisk financing

Insurance is one of the major forms of risk transfer, and it permits uncertainty to be replaced bycertainty through insurance indemnity

Insurance

• Refers to protection against an event that

might happen• Provides cover against a risk

Assurance

• Refers to protection against an event that will

happen• Covers an event that is definite

• Assurance policies are associated with lifecover

Insurance vs Assurance


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Chapter 1


How insurance indemnifies the insured


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Chapter 1


Insurance as a tool for managing risk

Considerations before opting forinsurance

Don’t risk a lot for a little

Don’t risk more than what you canafford to lose

Consider the likely outcomes of the riskcarefully


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Chapter 2

What Life Insurance Involves

Life insurance business –

Components, human life value, mutuality

Intro: This chapter explains the various components of life insurance

Asset: Human Life Value (HLV)

HLV concept considers human life as a kind of property or asset that earns an income

It measures the value of human life based on an individual’s expected net future earnings

Typical concerns faced by ordinary people

Dying too early Living too long Living with disability


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Chapter 2


The level premium is a premium fixed

such that it does not increase with age

but remains constant throughout the

contract period.

Level premium has two components

Term or protection component

It consists of that portion of premiumactually needed to pay the cost of the risk

Cash value element

It is made up of accumulated excess payments of thepolicyholder. It constitutes the savings component


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Chapter 2


Mutuality &

Diversification

Mutuality is one of the important ways to reduce risk in financial

markets, the other being diversification

Diversification

Under diversification the funds arespread out among various assets

(placing the eggs in different baskets).

Under diversification we have fundsflowing from one source to many

destinations

Mutuality

Under mutuality or pooling, the fundsof various individuals are combined

(placing all eggs in one basket).

Under mutuality we have funds flowfrom many sources to one


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IC-33 Life insurance

Chapter 3Legal Principles of Life Insurance

Insurance contracts – Legal aspects and special features

Intro: This chapter explains the elements that govern the working of a life insurance contract and also dealswith the special features of a life insurance contract.

Insurance

contract

Insurance involves a contractual agreement in which the insurer

agrees to provide financial protection against certain specified risks

for a price or consideration known as the premium

The contractual agreement takes the form of an insurance policy

Elements of a valid contract

Offer andacceptance

Consideration Agreement

betweenparties

Free consentCapacity ofthe parties

Legality


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Consent is said to be free when it is not caused by

CoercionUndue

influenceFraud Misrepresentation Mistake

Coercion

• It involves pressureapplied throughcriminal means

Undue influence

• When a person whois able to dominatethe will of another,uses his / herposition to obtain anundue advantageover the other

Fraud

• When a personinduces another toact on a false beliefthat is caused by arepresentation he orshe does not believeto be true. It canarise either fromdeliberate

concealment of factsor throughmisrepresenting them

Mistake

• Error in one’sknowledge or beliefor interpretation of athing or event. Thiscan lead to an errorin understanding andagreement about thesubject matter ofcontract


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Uberrima Fides orUtmost Good Faith

It means that every party to the contract must disclose all materialfacts relating to the subject matter of insurance

It is defined as involving “a positive duty to voluntarily disclose,accurately and fully, all facts material to the risk being proposed,

whether requested or not"

If utmost good faith is not observed by either party, the contract maybe avoided by the other

Material factsIt has been defined as a fact that would affect the judgment of an

insurance underwriter in deciding whether to accept the risk and if so,the rate of premium and the terms and conditions


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Insurable interest can be in

Self (Own life) Spouse’s life Children’s life Asset/s owned

Proximate cause

It is defined as the active and efficient cause that sets in motion

a chain of events which brings about a result, without the

intervention of any force started and working actively from a new

and independent source


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Chapter 4

Financial Planning

Financial planning and the individual life cycle

Intro: Life insurance must be understood in the wider context of “Personal Financial Planning”. The purposeof this chapter is to introduce the subject of financial planning

Financial Planning

It is a process of identifying one’s life’s goals, translating these

identified goals into financial goals and managing one’s finances in

ways that will help one to achieve those goals

Savings

Life, Death and Disease – the

3 contingencies

Consumption

Income

(Learner) (Earner) (Partner) (Parent) (Provider) (Empty Nester) (Twilight years)

The Economic Life

Cycle


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Chapter 4

Financial Planning

Childhood stage When one is a student or learner

Young unmarried stage When one has begun to earn a livelihood but is single

Young married stage

When one has become a partner or spouse

Married with young children stage When one has become a parent

Married with older children stage When one has become a provider who has to take care of education

and other needs of children who are growing older

Post family/Pre-retirement stage

When the children may have become independent and left thehouse, just as birds leaving an empty nest behind

Retirement stage When one passes through the twilight years of one’s life. One could

live with dignity if one has saved and made sufficient provisions

Life Stages

Savings may be considered as a composite of two decisions

Postponement of consumption: an allocation of resources between present and future consumption.

Parting with liquidity in exchange for less liquid assets. E.g. purchase of a life insurance policy implies

exchanging money for a contract which is less liquid. Financial planning includes both kinds of decisions.


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Chapter 4

Financial Planning

Role of financial planning

Elements of Financial Planning

InvestingRisk

ManagementRetirementPlanning

Tax and EstatePlanning

Financing one’sneeds

The challenges facing oursociety and our customers

Disintegration of the joint family

Multiple investment choices

Changing lifestyles

Inflation

Other contingencies and needs


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Chapter 4

Financial Planning

Financial planning - Types

Financial Planning Advisory Services

CashPlanning

InvestmentPlanning

InsurancePlanning

RetirementPlanning

TaxPlanning

EstatePlanning

Parameters on which investment decisions are based

DiversificationTax

ConsiderationsRisk Tolerance Time Horizon Liquidity Marketability

Phases of retirement

Accumulation Conservation Distribution


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Chapter 5

Life Insurance Products - I


Overview of life insurance products

Intro: This chapter discusses products in general, need for life insurance products and the rolethey play in achieving various life goals. It also discusses some traditional life insurance products.

What is a product?

From a marketing standpoint, a product is a bundle of attributes

The difference between a product (as used in a marketing sense) and a commodity is that aproduct can be differentiated. A commodity cannot.

Products may be

Tangible Intangible

Life insurance is a product

that is intangible

Customer value would depend on how life insurance is

perceived as a solution to a set of customer needs.

A rider is a provision typically added through an endorsement,which then becomes a part of the contract.


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Chapter 5



Traditional life insurance products

Traditional Life Insurance Products

Term InsurancePlans

Whole LifeInsurance Plans

EndowmentInsurance Plans

Term insurance policy

A term insurance policy comes handyas an income replacement plan

Considerations: Price is the primarybasis of competitive advantage in term

assurance plansVariants of Term

Assurance

Decreasing termassurance

Increasing termassurance

Term assurance withreturn of premiums

Whole Life

Insurance

There is no fixed term of cover but the insurer offers to pay the agreed upon

death benefit when the insured dies, no matter whenever the death might occur

A whole life policy is a good plan for one who is the main income earner of the

family and wishes to protect the loved ones from any financial insecurity in case

of premature death


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Chapter 5



Endowment Assurance: Combination of 2 plans:

A term assurance plan

Pays the full sum assured in case ofdeath of the insured during the term

A pure endowment plan

Pays this amount if the insured survivesat the end of the term

Money back plan

It is typically an endowment plan with the

provision for return of a part of the sum assured

in periodic installments during the term and

balance of sum assured at the end of the term

The unique selling proposition (USP) of term assurance is its low price, enabling one

to buy relatively large amounts of life insurance on a limited budget


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Chapter 6

Life Insurance Products - II


Overview of non-traditional life insurance products

Intro: This chapter discusses non-traditional life insurance products.

• The savings or cash value component in traditional life insurance policies is not well defined

Cash value component

• It is not easy to ascertain what would be rate of return on traditional life insurance policies

Rate of return

• The cash and surrender values (at any point of time), under these contracts depend oncertain values (amount of actuarial reserve and the pro-rata asset share of the policy)

Surrender value

• Finally there is the issue of the yield on these policies

Yield

Limitations of Traditional Life Insurance Products


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Chapter 6



Direct linkage with the investment gains

Inflation beating returns

Flexibility

Surrender value

Appeal: Major sources of appeal of the

new genre of products that emerged

worldwide are

Universal Life

Insurance

Universal life insurance is a form of

permanent life insurance characterised byits flexible premiums, flexible face

amount and death benefit amounts, and

the unbundling of its pricing factors

Non-traditional lifeinsurance products

Variable insuranceplans

Unit linked insuranceplans

Non-traditional life insurance products


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Chapter 6



Equity Fund Debt Fund Balanced Fund Money Market Fund

This fund invests

major portion of the

money in equity and

equity relatedinstruments.

This fund invests major

portion of the money in

Government Bonds,

Corporate Bonds, FixedDeposits etc.

This fund invests in a

mix of equity and debt

instruments.

This fund invests money

mainly in instruments

such as Treasury Bills,

Certificates of Deposit,Commercial Paper etc.

Break-up of ULIP Premium

Expenses Mortality Investment

Investment fund options offered by ULIPs


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Chapter 7

Pension and Annuities

Intro: This chapter discusses pension & annuity products, types of annuities and pension related

contingencies

Types of pension

Life insurance products Pension products

Purpose of product: Life insurance products have

been designed basically to provide protection against

the financial consequences of an individual’s early

and premature death.

Pension products provide protection against the

financial consequences that may arise when the

individual lives too long and thus outlives one’s

financial resources.

Contingency covered: In case of life insurance, the

basic contingency covered is that of mortality.

In case of pensions it is post-retirement income

discontinuity.

Product structure: In the case of life insurance, a

stream of premium payments results in creation of a

capital sum, known as the sum assured. This sum is

payable to the individual’s nominees or beneficiaries

in the event of death of the individual, or may be paidas a survival benefit at the end of the term in the

case of endowment policies.

In the case of pensions, a capital sum, which we may

call a corpus or total consideration gets liquidated in

part or whole through its conversion into a stream of

regular income payments. These are known as

annuities.

Difference between life insurance products and pension products


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Chapter 7


Types ofpensionschemes

Publicpensions

Personalpensions

Occupationalpensions


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Chapter 7


Classification of annuities

Basis of classification of annuities

How the annuity ispurchased

How often theannuity is paid

When the annuitypayment is due to

begin

Length of thepayout period

Whether theannuity amount isfixed or variable

Types of Annuities

Immediate Annuities

An annuitant receives payments after making an

initial investment. In an immediate annuity, anindividual pays a lump sum and begins to

receive income one annuity period later

Deferred Annuities

With a deferred annuity, money is invested for

a period of time until the annuitant is ready toreceive annuities. The deferred annuityaccumulates money for the term chosen by

the individual


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Chapter 7


Pensions – The value proposition

Pension related contingencies

Longevity risk

Inflation

Investment risk

Replacement income risk


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Chapter 8

Health Insurance


Health insurance policies

Intro: This chapter explains health insurance concepts, domiciliary hospitalisation, family floaterpolicies and group health insurance policies.

• It is a contract between the insurer and the insured wherein the insurer agrees to payhospitalisation expenses to the extent of an agreed sum insured in the event of any medicaltreatment arising out of an illness or an injury

Health insurance

• The sum insured floats among the family members. Family floaters usually cover husband,wife and two children

Family floater policies

• This means a facility extended by the insurer to the insured where the payments of the costsof treatment undergone by the insured in accordance with the policy terms and conditions,are directly made to the network provider by the insurer to the extent pre-authorisationapproved

Cashless facility

• This policy is available to groups/ associations/ institutions/ corporate bodies, provided theyhave a central administration point and are subject to a minimum number of persons to becovered. The group must belong to a category that is approved

Group health insurance policy


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Chapter 8

Health Insurance


Expenses covered under health insurance include

Cost ofroom / bed

Boardingexpenses

Nursingexpenses

Doctor’s

feesDiagnostic

tests

Operationtheatrecharges

Expensesrelated tosurgical

appliancesand the like

Terms in health insurance

Third Party Administrators (TPA)

• It means any person who is licensed under the IRDA (Third Party Administrators -Health Services) Regulations, 2001 by the Authority, and is engaged, for a fee orremuneration by an insurance company, for the purposes of providing health services

Portability

• It is the right accorded to an individual health insurance policyholder (including familycover), to transfer the credit gained for pre-existing conditions and time boundexclusions, from one insurer to another insurer or from one plan to another plan of thesame insurer, provided the previous policy has been maintained without any break


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Chapter 8

Health Insurance


Group

insurancepolicy forbank

customersmay cover

HomeLoans

Car Loans

Personal

Loans

Credit

Cards

EducationLoans


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Chapter 9

Applications of Life Insurance

Applications of life insurance

Intro: This chapter discusses various applications of life insurance.

Married

Women’s

Property

Act

Section 6 of the Married Women’s Property Act, 1874

provides for security of benefits under a life insurance policy

to the wife and children. Section 6 of the Married Women’s

Property Act, 1874 also provides for creation of a Trust

Beneficiaries underSection 6 of MWP Act

Wife aloneWife and one or

more children jointly One or more children


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Chapter 9

Applications of Life Insurance

Key man

Insurance

It can be described as an insurance policy taken out by a

business to compensate that business for financial losses

that would arise from the death or extended incapacity of an

important member of the business

Mortgage

Redemption

Insurance

(MRI)

It is an insurance policy that provides financial protection for

home loan borrowers. It is basically a decreasing term life

insurance policy taken by a mortgagor to repay the balance

on a mortgage loan if he / she dies before its full repayment


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Chapter 10

Pricing and Valuation in Life Insurance

Insurance pricing – basic elements

Intro: This chapter illustrates the basic elements that are involved in the pricing and benefits of life insurancecontracts

Insurance

contractRebates

Life insurance companies may offer certaintypes of rebates on the premium that is

payable. Two such rebates are:

For sum

assured

For mode of

premium


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Chapter 10


Components of Premium

Mortality InterestExpenses ofmanagement

Reserves Bonus loading

Adequacy

Equity

Competitiveness

Guiding Principlesfor determining

Amount of Loading

Gross premium = Net premium + Loading for expenses + Loading for contingencies + Bonus

loading


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Chapter 10


Surplus and Bonus

Determination

of surplus

and bonus

Every life insurance company is

expected to undertake a periodic

valuation of its assets and liabilities.

Such a valuation has two purposes:

To assess the financial stateof the life insurer, in other

words to determine if it is

solvent or insolvent

To determine the surplus

available for distribution

among policyholders / share

holders

Surplus is the excess of value

of assets over value of

liabilities. If it is negative, it is

known as a strain

Surplus = Assets - Liabilities

Surplus

At Book Value

• This is the valueat which the lifeinsurer haspurchased or

acquired itsassets

At Market Value

• The worth of thelife insurer’s

assets in themarket place

DiscountedPresent Value

• Estimatingfuture incomestream fromvarious assets

& discountingthem to present

Assets are valued in one of the following three w ays


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Chapter 10


BonusBonus is paid as an addition to the basic benefit payable undera contract. Typically it may appear as an addition to basic sum

assured or basic pension per annum

Types of Reversionary Bonuses

Simple ReversionaryBonus

Compound Bonus Terminal Bonus


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Chapter 10


Unit Linked Policies

They involve a different approach to the design of

products and follow a different set of principles

Unitising:

Benefits are

determined by

value of units

credited to theaccount at the

time of claim

Transparent

structure:

Charges for

insurance

protection and

expenses

component are

clearly specified

Pricing:

Insured decides

the amount of

premium and

insurance coveris a multiple of

premiums paid

Investment

risk: It is borne

by the insured


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Chapter 11Documentation – Proposal Stage

Life insurance – Proposal stage documentation

Intro: This chapter discusses the various documents that are involved at the proposal stage and theirsignificance.

Prospectus It is a formal legal document used by insurance companies that

provides details about the product

Prospectus used by a life insurance company should state the following, under each of its plans of insurance:

Terms and conditions

Scope of benefits – guaranteed and non-guaranteed

Entitlements

Exceptions

Whether the plan is participative or non-participative


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Proposal Form

The insurance policy is a legal contract between insurer and the policyholder. As is

required for any contract, it has a proposal and its acceptance. The application

document used for making the proposal is commonly known as the ‘proposal form’

Moral hazard

It is the likelihood that a client's behaviour might change as a result of purchasing a life

insurance policy and such a change would increase the chance of a loss

Ch t 11


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Valid age proof

Standard age proofs

• School or college certificate

• Birth certificate extracted from municipal records

• Passport

• PAN card

• Service register

• Certificate of baptism

• Certified extract from a family bible if it contains the date of birth

• Identity card in case of defence personnel

• Marriage certificate issued by a Roman Catholic Church

Non-standard age proofs

• Horoscope

• Ration card

• An affidavit by way of self-declaration• Certificate from Village Panchayat

Anti-Money

Laundering (AML)

It is the process of

bringing illegal moneyinto an economy by

hiding its illegal origin

so that it appears to

be legally acquired.

The Government of

India launched the

PMLA , 2002 to rein

in money-laundering

activities

Ch t 11


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Each insurer is required to have an AML policy and accordingly file a copy withIRDA. The AML program should include:

Internal policies,procedures and

controls

Appointment of aprincipal

compliance officer

Recruitment andtraining of agentson AML measures

Internalaudit/control

Know Your

Customer

(KYC)

It is the process used by a business to verify the identity of their clients

Chapter 11


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Agents should ensure that proposers submit the proposal formalong with the following as part of the KYC procedure

Photographs Age proof

Proof of address – driving license,

passport, electricitybill, bank passbook

etc.

Proof of identity – driving license,

passport, voter IDcard, PAN card, etc.

Income proofdocuments incase of high-

valuetransactions

Chapter 12


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Chapter 12

Documentation – Policy Condition: I

Policy stage documentation

Intro: This chapter discusses the various documents involved when a proposal becomes a life insurancepolicy.

First Premium Receipt (FPR)

An insurance contract commences when the life insurance company issues a FPR

The FPR is the evidence that the policy contract has begun

Chapter 12


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Chapter 12


First premium receipt contains

Name and

address of the

life assuredPolicy number

Premium

amount paid

Date of commencement

of the risk

Date of final maturity

of the policy

Date of payment of

the last premiumSum assured

Method and

frequency of

premium

payment

Next due date

of premium

payment

Chapter 12


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Chapter 12


Policy DocumentIt is evidence of the contract between the assured

and the insurance company

Policy document components

Policy Schedule Standard Provisions Specific Policy Provisions

Chapter 13


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Chapter 13

Documentation – Policy Condition: II


Policy conditions and privileges

Intro: This chapter discusses the provisions incorporated in a policy document.

Grace period

The “Grace Period” clause grants the policyholder an additional

period of time to pay the premium after it has become due

The standard length of the grace period is one month or 31 days

Reinstatement

It is the process by which a life insurance company puts back intoforce a policy that has either been terminated because of non-

payment of premiums or has been continued under one of the

non-forfeiture provisions

Policy revival measures

Ordinary revival

Special revival

Loan cum revival

Instalment revival

Chapter 13


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Chapter 13



Nomination

Nomination is where the life assured proposes the name of the

person(s) to whom the sum assured should be paid by the insurance

company after their death

A nominee does not have any right to the whole (or part) of the claim

Provisions of Section 39(Nomination)

Nomination can be made when the policy is bought or thereafter

Nomination is not applicable to Section 6 of MWP Act

Policy moneys payment is made to surviving nominee/s

Assignment cancels nomination

Addition, change or cancellation of nomination is allowed

Nomination shall be by endorsement

Chapter 13


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p



AssignmentThe term assignment ordinarily refers to transfer of property by

writing as distinguished from transfer by delivery

Conditional Assignment

• Conditional assignmentprovides that the policyshall revert back to the

life assured on his or hersurviving the date ofmaturity or on death ofthe assignee

Absolute Assignment

• Absolute assignmentprovides that rights, titleand interest of the

assignor in the policy aretransferred to theassignee withoutreversion to the former orhis / her estate in anyevent

• The policy vestsabsolutely with theassignee. The latter candeal with the policy in

whatever manner he orshe likes without theconsent of the assignor

Types of Assignment

Chapter 13


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Provisions of Section 38 (Assignment)

Assignment hasto be by

endorsement

Assignmentnotice shouldbe in writing

Insurer shouldrecord and

registerassignment

Assignmentcancels

nomination

Assignmentshould be

supported byvaluable

consideration

Assignee cando anotherassignment

Main types of alterations

Change in certain classes of insuranceor term

Change in the mode of payment of

premium

Splitting up of the policy into two or more

policies

Change from without profits to with

profits plan

Reduction in the sum assured

Change in the date of commencement of

the policy

Removal of an extra premium or

restrictive clause

Correction in name

Settlement option for payment of claim and grant of double accident benefit

Chapter 14


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Underwriting


Underwriting – Basic concepts

Intro: This chapter discusses the process of underwriting and the elements involved in theprocess.

Underwriting purpose

To prevent anti-selection or selectionagainst the insurer

To classify risks and ensure equityamong risks

Risk classification

Standardlives

Preferredrisks

Substandardlives

Declinedlives

Underwriting or theselection process

Field or Primary levelUnderwriting

department level

Methods ofUnderwriting

Judgment Method

Numerical Method

Chapter 14


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Underwriting


Underwritingdecisions

Acceptanceat ordinaryrates (OR)

Acceptancewith an extra

Acceptancewith a lien on

the sumassured

Acceptancewith a

restrictiveclause

Decline orpostpone

Chapter 14


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Underwriting


Non-medical underwriting

• A large number of life insurance proposals may typically get selected for insurance withoutconducting a medical examination to check the insurability of a life to be insured. Suchcases are termed as non-medical proposals

Non-medical underwriting

• Factors like income, occupation, lifestyle and habits, which contribute to moral hazard, areassessed as part of financial underwriting, while medical aspects of health are appraisedas part of medical underwriting

Rating factors in underwriting

Occupational hazards can emanate from any of three sources

Accidentalhazards

Health hazards Moral hazard

Chapter 14

U d iti


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Underwriting


Medical underwriting

Medical Factorsthat influence anUnderwriter’s

Decision

• Personal history

• Personal characteristics

• Family history

Chapter 15

P t U d A Lif I P li


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Payments Under A Life Insurance Policy

Intro: This chapter explains the concept of claim and how claims are ascertained.

Types of claims and claim procedure

Claim

A claim is a demand that the insurer should make good the promise specified in the contract

While a death claim arises only upon the death of the life assured, survival claims can be causedby one or more events

A maturity or death claim or a surrender leads to termination of the insurance cover under thecontract and no further insurance cover is available

Claims can be

Survival Claims Death Claims

Chapter 15

P t U d A Lif I P li


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Payments Under A Life Insurance Policy

Types of claims

Survival BenefitPayments

Surrender ofPolicy

Rider Benefit Maturity Claim Death Claim

Early (less thanthree years

policy duration)

Non-early (morethan three

years)

Forms to be submitted for Death Claim

Claim form by nominee

Treating physician’s certificate

Employer’s certificate

Certificate of burial or cremation

Hospital’s certificate

Certified court copies of policereports in case of death by

accident

Chapter 16

Regulatory Aspects


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Regulatory Aspects


Insurance regulations and regulatory framework

Intro: This chapter explains the importance of insurance regulations, the legal status of aninsurance agent and various rules and regulations applicable to agents.

Insurance

regulations The prime purpose of insurance regulation is to protect the policyholder

Entities regulated by IRDA

AgentsInsurance

CompaniesThird Party

AdministratorsSurveyors Brokers

Corporate Agents

The Insurance Act, 1938 has provisions for monitoring and control of operations of insurance companies

Chapter 16

Regulatory Aspects


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Regulatory Aspects


IRDA regulations prescribe insurers’ obligations

at the point of

sale

towards policy

servicingclaims servicing

control onexpenses,investment

financial strengthto meet the

commitments topolicyholders

Chapter 16

Regulatory Aspects


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Regulatory Aspects


Regulations and code of conduct applicable to insurance agents

Regulations applicable to insurance agents

As per the Insurance Act, 1938 (Section 42), to work as an insurance agent, onemust have a licence

IRDA deals with issuance of licences and other matters relating to agents recruitment

There are regulations which must be complied with at all stages in the process

Chapter 16

Regulatory Aspects


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Regulatory Aspects


• The applicant must possess the minimum qualification of a pass in 12th Standard or

equivalent examination, where the applicant resides in a place with a population of fivethousand or more as per the last census, and a pass in 10th Standard or equivalentexamination from a recognised Board / Institution if the applicant resides in any other place

Qualifications of the applicant

• The first time applicant for agency licence shall have completed from an IRDA approvedinstitution, at least, fifty hours’ practical training in life or general insurance business, whichmay be spread over two to three weeks

Practical training

• The applicant shall have passed the pre-recruitment examination in life or general insurancebusiness, or both, as the case may be, conducted by the Insurance Institute of India,Mumbai, or any other ‘examination body’

Examination

• The fees payable to the Authority for issue / renewal of licence to act as insurance agent orcomposite insurance agent shall be Rs. Two Hundred and Fifty or as amended from time totime

Fees payable

Chapter 17

Life Insurance Agency as a Career


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Insurance Channels

Intro: This chapter discusses life insurance agency as a career.

• As per Section 182 of the Indian Contract Act, an agent is a person employed to do anyact for another or to represent another in dealing with a third person

Agent

• The person for whom such act is done or who is represented is called the principal

Principal

• As per the Insurance Act, an agent is one who is licensed under Section 42 of the Act,authorised to be a salesman for insurance, and is paid commissions for soliciting, procuringand continuance of the business

Insurance agent

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Insurance channels

Individual Agency

Corporate Agency

Brokers Bancassurance Direct marketing

Telemarketing Mail marketing

Internet andweb basedmarketing

Work sitemarketing

Direct marketing

approaches

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Life insurance agency profession

Rewards of an agency career in life insurance

Being recognised by the society as a knowledge worker and aprofessional

Being able to provide solutions to some of the most criticalproblems of people around is a matter o f immense social value

that life insurance agents enjoy

Being able to help people by advising them to take the rightpolicy to cover their death or old age needs or an accident or anillness or meet other family needs can be a matter of immense

personal satisfaction for life insurance agents

They can become very skilled in dealing with various kinds ofpeople

Finally, the life insurance agency is one of the few avocationswhere one can be an entrepreneur

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Requirements for success in the life insurance agency profession

Fire in the belly Positive self-image Being a self-starter Ability to relate with

and communicate withpeople

Ethics and market conduct The term „Ethics‟ is used to denote a set of principles for

morally correct behaviour

Basic ethical principles to be followed

Do good and avoid

harmBe fair Keep your word Be true to yourself

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Major areas of unethical behaviour in insurance sector

Misrepresentation

Illustrations

Replacement

Advice

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Principles of the Insurance Marketplace Standards Association (IMSA)

Principle 1 To conduct business according to high standards of honesty and fairness and to render

that service to its customers which, in the same circumstances, it would apply to or

demand for itself.

Principle 2 To provide competent and customer-focused sales and service.

Principle 3 To engage in active and fair competition.

Principle 4

To provide advertising and sales material that is clear as to purpose and honest and fair

as to content.

Principle 5 To provide for fair and expeditious handling of customer complaints and disputes.

Principle 6 To maintain a system of supervision and review that is reasonably designed to achieve

compliance with these principles of ethical market conduct.

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Recruitment, training and licensing of agents

Guidelines on

persistency for

individual agents

Persistency during a period has been defined as“proportion of policies remaining in force at the end of the

period out of the total policies in force at the beginning of

the period.”

Agency function consists of two distinctive tasks:

Building a relation with the customer – which inspires trust and confidence

Providing expert financial advice to the customer – which enables the latter tomeet his or her needs for insurance in the most appropriate manner

Chapter 18

Life Insurance Selling Process


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Intro: This chapter illustrates the life insurance selling process and its various steps.

Sales process

Selling

Selling as a profession refers to the act of inducing a commercial transaction through

inducing the purchase of a product or service, such act being carried out with the

intent of earning remuneration

Insurance agents are sales persons who seek to induce members of the community tobuy insurance contacts written by the insurance company that they represent

The remuneration they enjoy in return is known as a commission

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Sales Process

Identify and build up a list of prospects

Develop by qualifying the list of prospects

Approach to get appointments with these people

Gather information and unearth the need/s

Capture the priority need with the help of ‘Dreams and Aspirations’

Presenting the solutions effectively

Closing the sale: overcoming objections (if any)

Sales-follow through

Policy delivery

Commit to ‘after sales service’

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• It is a name of another potential prospect which is provided as a lead, by your client or

prospect or centre of influence or any other person, whom you may be able to support withyour solutions

Reference

• It is a kind of statement which one may seek from a satisf ied customer, aff irming that thelatter has done business with the salesperson and has been very satisfied with the servicesand solutions rendered

Testimonial

• "Qualified" prospects are those people :• who can pay for insurance,

• who can pass the company underwriting requirements,

• who have one or more needs for insurance products, and

• who can be approached on a favourable basis

Qualified prospects

• In need analysis method we do the following things:

• the present and the future needs of the family are analysed;

• the monetary value of these needs are then calculated;• the difference between the funds so needed to meet these needs and the available fund

with the family as at present is ascertained

Need Analysis Method

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• One of the important techniques that one can use for handling objections is known asLAPAC (Listen, Acknowledge, Probe, Answer and Confirm)

Handling objections through LAPAC

• Closing is the process of persuading the prospect to buy now. The key to successfulclosing lies in helping the prospect to want to say "yes"

Closing the sale

• Service on the part of the agent is an integral element of the sales cycle. Essential to acommitment to service is a structured program for maintaining contact with our clients.Such a program could consist of:

• Conveying clearly

• Committing to continuous contact

• Annual service review plan

Commitment to service

Chapter 19Customer Service


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Importance of customer service

Intro: This chapter explains the importance of customer service, the role of agents in providing service tocustomers and how to communicate and relate with the customer.

‘SERVQUAL’ highlights five majorindicators of service quality

Reliability Responsiveness Assurance Empathy Tangibles

Customer lifetime value

It may be defined as the sum of economic benefits that

can be derived from building a sound relationship with a

customer over a long period of time



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Customer lifetime value

Historical Value

Premiums and other revenuesthat have been received in the

past from customer

Present Value

Present value of futurepremiums that may be expected

to be received if existingbusiness is retained

Potential Value

The value of premiums thatcould be derived by persuadingthe customer to buy additional

products



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Communication skills

Trust

Attraction Communication Being Present

Oral Written

Non-verbalUsing body

language

Communication may take

place in several forms:



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Non-verbalcommunication

Making a greatfirst impression

Be on time always

Present yourself appropriately

A warm, confident and winningsmile

Being open, confident and positive

Interest in the other person

Body Language

Confidence

Trust



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Active Listening

is where we consciously try to hear not only the words

but also, more importantly, try to understand the

complete message being sent by another

Elements of active listening

Paying Attention

Demonstratingthat you are

listening

Providefeedback

Not beingJudgmental

Respondingappropriately

Empatheticlistening

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Grievance Redressal Mechanism


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Grievance redressal mechanism

Intro: This chapter explains Grievance Redressal Mechanism and IRDA guidelines for it.

Integrated Grievance Management System(IGMS)

• IRDA has launched IGMS which acts as acentral repository of insurance grievance dataand as a tool for monitoring grievance redress inthe industry

The Consumer Protection Act, 1986

• The Act was passed “to provide for betterprotection of the interest of consumers and tomake provision for the establishment ofconsumer councils and other authorities for thesettlement of consumer’s disputes”.

• The Act has been amended by the ConsumerProtection (Amendment) Act, 2002

• “Consumer disputes redressal agencies” areestablished in each district and state and atnational level

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Judicial Channels

National Commission

Established by centralgovernment by notification

Entertains: complaints, wherevalue of the goods or services

and compensation, is any,claimed exceeds Rs. 1 Croresand appeals against the order

of any State Commission

State Commission

Established by state governmentby notification

Entertains: complaints wherethe value of goods/services andcompensation, if any, claimed

exceeds Rs. 20 lakhs but doesnot exceed Rs. 100 lakhs andappeals against the order ofany district forum within the

state

District Forum

Established by stategovernment in each district

Entertains: complaints, wherevalue of the goods or servicesand the compensation claimed

is up to Rs.20 lakhs

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The Insurance Ombudsman

The Ombudsman, by mutual agreement of the insured and the insurer can act as amediator and counsellor within the terms of reference

The decision of the Ombudsman, whether to accept or reject the complaint, is final

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• Rejected the complaint or

• The complainant had not received any reply within one monthafter receipt of the complaint by the insurer

The complainant had made a previous writtenrepresentation to the insurance company and theinsurance company had:

The complainant is not satisfied with the replygiven by the insurer

The complaint is made within one year from thedate of rejection by the insurance company

The complaint is not pending in any court orconsumer forum or in arbitration

Complaints

can be madeto the

Ombudsman

if:

IC-33 Key Notes Combined

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Transcript of IC-33 Key Notes Combined